Low Dose Rituximab in Thrombotic Thrombocytopenic Purpura

Status:Active, not recruiting
Therapuetic Areas:Hematology
Age Range:18 - Any
Start Date:August 2012
End Date:July 2020

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Adjuvant Low Dose Rituximab for Acquired TTP With Severe ADAMTS13 Deficiency

Thrombotic thrombocytopenic purpura (TTP) is a disease characterized by small blood clots
throughout the body that can damage major organs and cause death. TTP is treated with plasma
exchange (also called "plasmapheresis"). Patients who do not respond initially to plasma
exchange often are helped by later treatment with rituximab. The purpose of this study is to
see whether combining low doses of rituximab with plasma exchange will help patients get
better sooner and reduce the chance of getting TTP again.

This is a pilot safety/efficacy study of adjuvant low dose rituximab (100 mg/week x 4 doses)
plus standard plasma exchange and corticosteroids for the treatment of thrombotic
thrombocytopenic purpura (TTP) with severe ADAMTS13 deficiency. Results for study subjects
will be compared to historical controls treated initially with plasma exchange and
corticosteroids. This study proposes to test the hypothesis that adjuvant low dose rituximab
may decrease the incidence of a composite primary endpoint (exacerbations or refractory
disease) in acquired TTP with severe ADAMTS13 deficiency. A novel ADAMTS13 assay will be used
to identify patients with TTP and severe ADAMTS13 deficiency for enrollment, and to assess
the utility of ADAMST13 as a biomarker for response to therapy and prognosis.

Inclusion Criteria:

1. Age 18 or greater

2. Diagnosis of suspected thrombotic thrombocytopenic purpura (TTP)

1. Platelet count of < 80,000 for newly diagnosed patients and < 120,000 for
relapsed patients

2. Microangiopathic hemolytic anemia with RBC fragmentation

3. LDH >1 x ULN

3. Subjects who will receive treatment for TTP with plasma exchange

4. Subjects who have not started the 5th plasma exchange

5. Plasma ADAMTS13 activity <10%

Exclusion Criteria:

1. Treatment for TTP within the past 2 months

2. Severe active infection indicated by sepsis (requirement for pressors with or without
positive blood cultures) or clinical evidence of enteric infection with E. coli
O157:H7 or related organism

3. Currently under treatment for cancer (subjects with localized skin carcinoma will be

4. Microangiopathic hemolytic anemia due to a mechanical heart valve

5. Severe hypertension, as defined by systolic BP >180 AND diastolic BP >120, or

6. Organ or stem cell transplant

7. Use of calcineurin inhibitors (sirolimus, tacrolimus, cyclosporin A) within 6 months
prior to diagnosis of TTP

8. Disseminated intravascular coagulation as defined by:

a. INR >2.0 (unrelated to anticoagulation, unresponsive to Vitamin K) or b. Fibrinogen
<100 mg/dl

9. Pregnancy

10. Known congenital TTP.

11. Rituximab within the previous year.

12. HIV history or positive serology

13. History of hepatitis B or positive serology for HBsAg or Anti-HBc

14. Persistent or unexplained platelet count below 150,000/μL within 3 months of current
TTP presentation

15. Hypersensitivities or allergies to murine and/or humanized antibodies

16. Current participation in trials of investigational therapies or devices, other than
central catheters
We found this trial at
330 Brookline Ave
Boston, Massachusetts 02215
Principal Investigator: Jeffrey Zwicker, MD
Phone: 617-667-1939
Beth Israel Deaconess Medical Center Beth Israel Deaconess Medical Center (BIDMC) is one of the...
Boston, MA
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201 Dowman Dr
Atlanta, Georgia 30303
(404) 727-6123
Principal Investigator: Ana Antun, MD
Phone: 404-778-4334
Emory University Emory University, recognized internationally for its outstanding liberal artscolleges, graduate and professional schools,...
Atlanta, GA
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2301 Erwin Rd
Durham, North Carolina 27710
Principal Investigator: Ara Metjian, MD
Phone: 919-681-2668
Duke Univ Med Ctr As a world-class academic and health care system, Duke Medicine strives...
Durham, NC
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Saint Louis, Missouri 63110
Principal Investigator: J E Sadler, MD
Phone: 314-362-9998
Saint Louis, MO
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